An Italian study, the first outcome of a large epidemiological investigation, finds new beneficial effects of chocolate in the prevention of cardiovascular disease.

Maybe gourmands are not jumping for joy. Probably they would have preferred bigger amounts to support their passion. Though the news is still good for them: 6.7 grams of chocolate per day represent the ideal amount for a protective effect against inflammation and subsequent cardiovascular disease. A new effect, demonstrated for the first time in a population study by the Research Laboratories of the Catholic University in Campobasso, in collaboration with the National Cancer Institute of Milan.

The findings, published in the [October 2008] issue of The Journal of Nutrition,* official journal of the American Society of Nutrition, come from one of the largest epidemiological studies ever conducted in Europe, the Molisani Project, which has enrolled 20,000 inhabitants of the Molise region so far.** By studying the participants recruited, researchers focused on the complex mechanism of inflammation.

It is known how a chronic inflammatory state represents a risk factor for the development of cardiovascular disease, from myocardial infarction to stroke, just to mention the major diseases.

• Keeping the inflammation process under control has become a major issue for prevention programs

• And C reactive protein turned out to be one of the most promising markers, detectable by a simple blood test.

The Italian team related the levels of this protein in the blood of examined people with their usual chocolate intake. Out of 11,000, researchers identified 4,849 subjects in good health and free of risk factors (normal cholesterol, blood pressure and other parameters). Among them, 1,317 did not use to eat any chocolate, while 824 used to have chocolate regularly, but just the dark one.

"We started from the hypothesis that high amounts of antioxidants contained in the cocoa seeds, in particular flavonoids and other kinds of poly-phenols, might have beneficial effects on the inflammatory state,” says Romina di Giuseppe, lead author of the study. “Our results have been absolutely encouraging: People having moderate amounts of dark chocolate regularly have significantly lower levels of C-reactive protein in their blood. In other words, their inflammatory state is considerably reduced."

“The 17% average reduction observed may appear quite small, but it is enough to decrease the risk of cardio-vascular disease for one third in women and one fourth in men. It is undoubtedly a remarkable outcome.”

Chocolate amounts are critical. "We are talking of a moderate consumption. The best effect is obtained by consuming an average amount of 6.7 grams of chocolate per day, corresponding to a small square of chocolate twice or three times a week. Beyond these amounts the beneficial effect tends to disappear".

From a practical point of view, as the common chocolate bar is 100 grams, the study states that less than half a bar of dark chocolate consumed during the week may become a healthy habit.

What about the milk chocolate? "Previous studies – the young investigator continues – have demonstrated that milk interferes with the absorption of polyphenols. That is why our study considered just the dark chocolate."

Researchers wanted to sweep all the doubts away. They took into account that chocolate lovers might consume other healthy food too, such as wine, fruits and vegetables. Or they might exercise more than other people do. So the observed positive effect might be ascribed to other factors but not to cocoa itself. "In order to avoid this,” the researcher says, “we ‘adjusted’ for all possible ‘confounding’ parameters. But the beneficial effect of chocolate still remained and we do believe it is real."

"This study is the first scientific outcome published from the Molisani Project,” says Licia Iacoviello, Head of the Laboratory of Genetic and Environmental Epidemiology at the Catholic University of Campobasso and responsible for the Molisani Project. “We consider this outcome as the beginning of a large series of data which will give us an innovative view on how [to pursue] prevention in everyday life, both against cardiovascular disease and tumors."

"Maybe the time has come to reconsider the Mediterranean diet pyramid and take the dark chocolate off the basket of sweets considered to be bad for our health," adds Giovanni de Gaetano, director of the Research Laboratories of the Catholic University of Campobasso.

* * The Molisani Project, carried out by the Research Laboratories of the "John Paul II" Center for High Technology Research and Education in Biomedical Sciences at the Catholic University in Campobasso, started in March 2005. [It is] funded by the Pfizer Foundation and aims to recruit 25,000 citizens living in the Molise region, in order to investigate environmental and genetic factors responsible for cardiovascular disease and tumors. Until now, researchers have recruited more than 20,000 people and the final number is going to be reached by the end of 2008. The Molisani study is changing the face of a whole Italian region, turning it into a large scientific laboratory. From clinical tests to electrocardiograms, from blood pressure to spirometry, from dietary habits to physical exercise: it is a huge amount of information collected from each participant.